Camp Tinker’s FurrBabies,LLC

 Information

Owner Information

Name: ________________________________________________________________

Address: ______________________________________________________________

Home phone: ___________________________ Work Phone:____________________

Email: __________________________  Is it ok to send pictures/updates to this email?

Cell Phone: ___________________________ DOES YOUR CELL PHONE GET TEXT MESSAGES AND PICTURES?? ______

 Emergency Contact – Other than yourself

Name: ________________________________________________________________

Home phone: __________________________ Work phone: ______________________

List any person authorized to pick-up your dog if you cannot: THEY MUST SHOW I.D.: _______________________________________________________________________

Pet Information

Name: ________________________ Breed: ___________________ Sex: ___________

Age: ________________ Weight: ________________   Birthdate:  ________________

Veterinarian

Name: ________________________________________________________________

Address: ______________________________________________________________

Phone: ______________________________________

General Information

Dog's Name: ___________________  

Where did you get your dog? _______________________________________________

If adopted, do you have any knowledge of your dog's past history? _________________

_______________________________________________________________________

How did you hear about Camp Tinker’s Furrbabies, LLC? _____________________________

Health/Grooming

At what age was your dog spayed/neutered? ___________________________________

Is your dog current on ALL vaccinations?_______yes________no

Is your dog currently on heartworm prevention? ________________

What flea program is your dog on? ________________________________________________

Is your dog on any medications?   WHEN AND HOW USE BACK OF FORM!!_

What type of dog food do you feed your dog?________________________________________

Is it okay to give your dog treats during the day?______________________________________

Does your dog have hip dysplasia? ________ yes ________ no

If yes, what restrictions need to be placed on your dog's activities or movements? ___________

Does your dog have any allergies? ______________________________________________

Does your dog like to be brushed? ________ yes ________ no

Do you regularly clean your dogs teeth_________ ears__________?

How does your dog react to having his/her nails clipped? ____________________________

Does your dog have any sensitive areas on his/her body? ____________________________

Behavior

Does your dog act afraid of any specific items or noises? If so, please explain: ___________

___________________________________________________________________________ 

Are there any kinds of dogs your dog automatically fears or dislikes? _____________________

_____________________________________________________________________________

How does your dog react to puppies? _______________________________________________

Where does your dog sleep at home? (In bed, crate, dog bed)_____________________________

Has your dog ever:

Growled at someone? ______ yes _______ no

What were the circumstances: ________________________________________________________________

________________________________________________________________

Bitten someone? ______ yes ________ no

What were the circumstances: ________________________________________________________________

________________________________________________________________

Does your dog have any problems in any of the following areas: (if so, please explain)

Mouthiness: ____________________________________________________________

Housetraining: ___________________________________________________________

Barking: _______________________________________________________________

Jumping: ______________________________________________________________

Others: ________________________________________________________________

Has your dog ever growled or snapped at anyone who has taken his/her food or toys away from him/her? ________ yes ________ no

Has your dog ever shared his/her food or toys with other animals? __________________

Does you dog play with any toys? ______ yes ______ no

 If yes, what kind of toys does your dog like and what games does he/she play?

_______________________________________________________________________

How often does your dog meet new dogs it does not already know? _________________

Has your dog ever been in a dog fight?  If so what happened? ______________________

________________________________________________________________________

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Has your dog ever had any formal obedience training? ______ yes ______ no

If yes, when and where? ___________________________________________________

What commands does your dog know? ________________________________________

Does your dog know a bathroom command? ____________________________________

Does your dog know a quiet command? _______________________________________

Does your dog know any play commands? _____________________________________

Other comments about your dog that you feel might be helpful:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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 Health and Temperament Certification

I, _______________________________, hereby certify that my

dog ___________________  is in good health and has not been ill with any

 communicable condition in the last 30 days.

I further certify that my dog has not harmed or shown aggressive or threatening behavior towards any person or any other dog.

 

Date: __________   Signature of Owner:____________________    

 

*Please attach copy of vet records showing dates of vaccinations and bordatella      

  Camp Tinker’s Furrbabies, LLC.

1609 State Highway Y

Forsyth, MO 65653

Phone: 417-251-0248

 

Terms and Conditions Agreement

 

1.       I understand that I am solely responsible for any harm caused by my dog while my dog is attending daycare at Camp Tinker’s Furrbabies, LLC. or is using any other services provided.

2.       I further understand and agree in admitting my dog that Camp Tinker’s Furrbabies, LLC. has relied on my representation that my dog is in good health and has not harmed or shown aggression or threatening behavior toward any person or any other dog.

3.       I further understand and agree that Camp Tinker’s Furrbabies, LLCand their staff and volunteers will not be liable for any problems that develop provided reasonable care and precautions are followed.  I hereby release Camp Tinker’s Furrbabies, LLC, their staff, and volunteers of any liability of any kind whatsoever arising from my dogs’ attendance and participation.

4.       I further understand and agree that any problem that develops with my dog will be treated as deemed best by the staff at Camp Tinker’s Furrbabies, LLC, in their sole discretion, and that I will assume full financial responsibility for any and all expenses involved.  I authorize Camp Tinker’s Furrbabies, LLC to obtain medical records and/or treatments for my dog in the event of injury or illness from my veterinarian or from the closest veterinary clinic.  By signing this document I further direct said veterinarian to provide such records upon request.

5.       I further understand that if I fail to provide proof of current vaccinations or if my dogs’ vaccinations are found to be expired or otherwise incomplete, Camp Tinker’s Furrbabies, LLC has the right to refuse service until current proof is provided.  If my dog arrives at the facility with fleas and/or other parasites, Camp Tinker’s Furrbabies, LLC  has the right to bathe and quarantine my dog until picked up by myself or my agent, and I take full responsibility for any expenses incurred for such reasons.

6.       I further understand that my dog may experience minor cuts, scratches, and abrasions due to the nature of dog play.  I realize that pads on paws may initially become sensitive, or bothered until my dog becomes used to running on different surfaces.

7.       I further understand that Camp Tinker’s Furrbabies, LLC. is a place where animals co-mingle in groups and I am responsible for the medical treatment of any injuries that my dog receives.

8.       I allow my dog to be photographed, videotaped, and/or used in any media or advertising without prior approval by me.  All such photographs, ect. are the property of Camp Tinker’s Furrbabies, LLC.

9.       I further agree to all fees set forth by Camp Tinker’s Furrbabies, LLC and understand that I will be charged for no shows and I will be charged $5.00 per hour past scheduled pickup time.

 

I certify that I have read and understand the terms and conditions set forth on this page, the application, and health forms.  I agree to abide by the terms and conditions and accept all terms, conditions, and statements of this agreement.

 

Name of owner and dog (please print): _____________________________________

 

Signature of owner:    _____________________________________

 

Date:   _____________________________________